Ebola Talking Points
UPDATED: October 15, 2014
Key Messages
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While we understand that this is rapidly evolving situation, we need clear guidance and clarity
from the CDC in order to provide the best patient care, protect health care workers and
contain this outbreak.
As the premier organization for all registered nurses, we want procedures in place to ensure
that all patients receive the highest quality care and that all nurses and health care workers
are protected.
It is only through rapid review and learning from this situation that we will prevent further
incidents from happening.
We have requested full and timely information from the CDC regarding the situation, or what
new recommendations may be warranted to protect nurses and other members of the healthcare team.
Call for Nurses
The U.S. Department of Health & Human Services is holding a call on Thursday, Oct. 16 on Ebola
Preparedness. Please note: This call will likely reach capacity, so we strongly encourage nurses to
gather together in groups to dial in and listen.
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What: Conference call with nurses across the United States and officials from the U.S.
Department of Health and Human Services to discuss protecting the health of nurses while
safely caring for a patient with Ebola. Please share this invitation with members of your
organization.
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When: Thursday, October 16, 1:30 to 2:30 p.m. ET
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How: Dial-in: 1-888-395-7964
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Passcode: 6429111
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Leaders from: HHS Assistant Secretary for Preparedness and Response, the Health Resources
and Services Administration and the CDC.
PLEASE NOTE ***This call is closed to the media***
What we know as Wednesday afternoon, Oct. 15
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Unfortunately, a second nurse who cared for an Ebola patient at a Dallas hospital has contracted
the virus herself. The worker, identified by media outlets as Amber Vinson, was quickly moved
into isolation at Texas Health Presbyterian Hospital
Media outlets are reporting that she was isolated within "90 minutes" of her temperature being
taken. However, she’d flown to Dallas from Cleveland the day before her temperature rose.
Federal officials are tracking down people who were on the same flight
CNN is reporting that the nurse will be moved from a hospital in Dallas to Emory University
hospital in Atlanta.
Point of emphasis: You cannot spread Ebola before you have symptoms, and people need close
contact with bodily fluids to catch it.
The CDC is establishing an Ebola response team composed of experts for any hospital anywhere
in the country that has a confirmed case of Ebola, among other changes (see below under
Changes in CDC Response)
Background
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The current Ebola outbreak is the largest in history and is primarily affecting countries in West
Africa, including Guinea, Liberia, Nigeria and Sierra Leone.
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On Sept. 30, the Centers for Disease Control and Prevention (CDC) confirmed the first travelrelated case of the disease in the United States at Texas Health Presbyterian Hospital in Dallas.
The patient, Thomas Eric Duncan, died from the disease on Oct. 8
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On Oct. 12, the CDC announced that a nurse employed by Texas Health Presbyterian Hospital in
Dallas, Nancy Pham, had tested positive for Ebola.
o Pham is currently in stable condition and is in isolation. The nurse was a member of the
heath care team that provided care to Thomas Eric Duncan while he was in isolation in
the hospital.
o The nurse wore full protective gear while caring for Duncan.
o There were at least 76 health-care workers who may have come into contact with
Thomas Eric Duncan after he was hospitalized.
o On Monday, Oct. 13 Pham received a blood transfusion from American Ebola survivor
Kent Brantly and is "clinically stable."
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The World Health Organization estimates that there will be 5,000 to 10,000 new Ebola cases
weekly in West Africa by the first week of December.
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Officially WHO has reported only 8,914 Ebola cases total in the entire months-long outbreak, but
it has said that the total is under-reported. The mortality rate in this outbreak is about 70%.
Sources: CDC, Cnn.com. NBCNews.com
Talking Points
Changes in CDC Response
We are encouraged that the CDC is modifying its response to this situation. For example:
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Sending an additional team to Dallas, including experts who successfully controlled
outbreaks of Ebola in Africa in the past two decades, including in health-care settings. Team
members have worked with Doctors Without Borders on infection control protocols and
trained others in Africa to follow those protocols. This expertise is being directly shared with
the hospital. In addition, two infection control nurses from Emory University hospital who
have experience treating Ebola patients without infecting health-care workers are joining
the response at the Dallas hospital to provide peer-to-peer training and support. This
combination of training will help hospital staff across a range of care and management
experiences.
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Making immediate and specific improvements to processes and procedures at the Dallas
hospital to reduce risk to health care personnel. Care for a patient with Ebola requires
meticulous attention to detail, and refining these steps makes it safer and easier.
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Having a site manager in place and at the Dallas hospital 24/7 as long as Ebola patients are
receiving care, to oversee the putting on and taking off of PPE and the care given in the
isolation unit.
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Establishing a dedicated CDC response team that could be on the ground within a few hours
at any hospital with a confirmed patient with Ebola. The CDC Response Team would provide
in-person, expert support and training on infection control, healthcare safety, medical
treatment, contact tracing, waste and decontamination, public education and other issues.
The CDC Response Team would help ensure that clinicians, and state and local public health
practitioners, consistently follow strict standards of protocol to ensure safety of the patient
and healthcare workers.
CDC Concerns
Despite the CDC’s encouraging changes in response tactics, we still have concerns:
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Given the severity of this situation, it is essential that the CDC quickly investigate and fully share
the findings surrounding the care of Thomas Eric Duncan to help health care providers
understand any further precautions needed to prevent transmission of the disease, so that all
health care workers are protected.
We need to know what exactly happened that led to two nurses becoming infected with Ebola.
This is deeply troubling
We need to know exactly what went wrong so that we can provide high quality care to patients
and protect the people who care for them
We understand that the CDC is reconsidering its response. What is needed now is clear guidance
and leadership.
In addition to the CDC, ANA is reaching out to the World Health Organization (WHO), Doctors
Without Borders, the International Medical Corps, Emory University and other organizations
with experience in caring for Ebola patients for best practices and recommendations that we
can share with our members.
Personal Protective Equipment: (PPE)
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Given that PPE is the only line of defense for nurses and health care workers charged with caring
for Ebola patients, we have concerns:
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There are significant differences between what the CDC and WHO recommends for the
use of PPE when caring for Ebola patients. It’s not clear if the CDC is considering revising
current recommendations to align with WHO’s more stringent recommendations.
The CDC’s PPE guidelines need to be re-evaluated and possibly modified to better
protect members of the health care team.
Education in the proper use of PPE by health care workers while caring for Ebola
patients is critical to prevent exposure and transmission of Ebola. We believe the CDC
should initiate more direct contact with health care organizations to recommend a
review of current policies, and ensure that staff providing direct care are competent in
the use of appropriate PPE, have passed a medical evaluation and have been recently fit
test.
Inter-departmental Communication
In regards to health care workers and their role in patient care:
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Please remember: Providing patient care in busy emergency departments and other health care
settings is complex.
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When an error or omission occurs while treating a patient, instead of playing a blame game, it is
time for the entire health care team to review its processes and checklists in order to learn from
emerging situations, improve the flow of information and continuously improve practices that
result in improved safety for everyone involved.
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We offer our support to the nurses, their families, colleagues and community at this difficult
time.
General Points
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Given the recent developments in this rapidly evolving situation, we continue to urge all
hospitals and health care workers to engage in comprehensive education and preparedness
activities in order to ensure the safety of the public and health care professionals.
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Successfully containing Ebola will require inter-professional collaboration and working in teams
of nurses, physicians and other health care providers to properly treat and stop the spread of
the disease.
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At ANA our focus is to support increased awareness and education, reinforcing the need for
nurses to take appropriate precautions and stay informed about Ebola and other infectious
diseases.
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We have shared and will continue to share resources with our members and others via email
communications, website updates and social media. They have been eager to receive and
share information.
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Since the Dallas Ebola case went public on Sept. 30, it’s apparent that more health care
professionals and hospitals are watching the situation closely and have stepped up their
vigilance, reinforcing the knowledge and processes necessary to be prepared. Whenever there
is heightened awareness about a potential risk, we expect to see more vigilance and enhanced
reporting. For example:
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Given that a second health care worker has been infected, it’s not surprising that nurses
and health workers are concerned and want additional education about best practices
for treatment and protection.
We (nursing organizations) share a common goal of ensuring preparedness and
underscoring the need for ongoing education and reinforcement of protocols.
In any emergency or infectious disease outbreak, health care teams must be constantly vigilant
and seek out the latest information and evidence-based practices to respond to the evolving
situation.
Patient and Health Worker Safety
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It is critically important that all health care team members have appropriate knowledge,
education and personal protective equipment to ensure safety and effectively provide care to
patients.
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ANA also underscores the need to practice meticulous infection control at all times.
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Another key strategy that can help nurses stay safe is knowing not only how to don personal
protective equipment but also how to remove it in the correct order.
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Recognizing the concern about Ebola, it’s important to remember that whether RNs are dealing
with enterovirus-D68, the flu or even the common cold, strictly following the standard, practical
precautions that have long been part of nursing’s preventive repertoire is crucial. Those
precautions include proper hand hygiene, vaccination for influenza, and respiratory hygiene.
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We have the utmost confidence that health care providers are eager to take part in learning
protocols that will protect health care workers and keep patients safe.
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